All GLG News Analyses Filed Under: Cardiology

PCI numbers will not drop after Courage

August 19, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

the impact will be small. The study is not a big surprise. No cardiologist thought he is saving lives stenting arteries in stable patients. The study required every one to get an angiogram if they had an abnormal stress test to qualify. We probably already not refer every abnormal test for cath using clinical judgement and severity of the abnormality. It is somewhat of a surprise that stents the way there are applied in real life actually do not have a negative outcome result. Once an angiogram is done. many factors interfere including patient expectations, some clinical factors and unfortunately some unethical financial incentive that will probably cause the PCI to still be done in most patients exactly like before courage. The study does not affect unstable angina and acute MI obviously. PCI in these conditions should continue unchanged. Until a study comes that empowers the non-invasive cardiologist to not refer pts with abnormal stress test for LHC, PCI will not drop.

Bad News (but not new news) for stents.

August 19, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

Once again, we see that medications in most cases are as effective as stenting.  This is old news dating back to the CASS trial in the 1970's and 1980's. Every time we come up with a slick new device we test it against the standard of care and it comes up more expensive and no more effective.  First it was CABG, then PTCA (angioplasty) then stenting, then DES.  Suprisingly, it gets treated like new news everytime the wheel is reinvented.  Coronary atherosclerosis is a systemic and diffuse problem that requires to be treated in kind, rather than with local therapy.  The average stent covers 1/5,000,000 of the total area of the coronary vasculature.  Not new news that medications work.

Courage trial should redefine care in America

August 18, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

Most hospitals are financially built on their heart programs. The "agressive" medical arm is conservative by our standards yet as good as stents at far less cost. If this was truly pursued by large companies with TPA insurance plans, their overall cost would drop with large savings in healthcare costs. They will need to eliminate disincentives (copays) to proper prescribing, replacing them with incentives to providers to effect rapid change. If this is done, it will cost cardiologist, cardiac surgeons, and their supporting hospitals their profitability while saving all the other sectors.

Stents vs Coronary Surgery

August 18, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

As a sales executive in the cardiac surgery market for many years, I have been involved with many aspects of this industry as well as having met many cardiac surgeons and seen numerous coronary surgeries. Overall, the success rate with stents is poor vs coronary bypass and certain follow up medications. The ratio of success vs failure is impressive when studying the success of stents.   Edward C. Saenz Westport, CT

Not too surprising a result

August 18, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

You can only open up an artery so far. Whether you achieve this with drugs, or a mechanical device doesn't seem to matter as long as the blood gets flowing again.

Stents vs. Drugs: Same for Patients, Very Different for Providers

August 18, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

To stent or not to stent: presence and degree of coronary artery disease, effectiveness of medical therapy and significance of symptoms and, therefore, indications for coronary stents placement are determined by very same physicians who place stents. Stents are reimbursed 10-20 times better than medical management.

Less and less evidence to favor coronary stenting

August 15, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

This study pretty convincingly shows that there is only a short term symptom and quality of life improvement associated with coronary stenting, as compared to good quality pharmacological treatment. This will decrease the pressure for aggressive revascularization of any and all coronary lesions (which has been pushed by many interventionalists). If the results are accepted by the health insurance industry then there may resistance to reimbursement by payors also. One critique of the study has been that the PCI group did not have a higher use of drug eluting stents. Given that DES have not been shown to reduce MI or mortality, this critique does not hold water (and the same criticism of out of date PCI has been made of every medical vs PCI trial ever since the RITA trials). A related critique is that the medical therapy group was 'too good'; this one is also a recurring complaint in 20 years of PCI trials. 

Statin therapy for children

August 6, 2008

Analysis by: GLG Expert Contributor

Analysis of:8-Year-Olds on Statins? A New Plan Quickly Bites Back | www.nytimes.com

The  potential market for treatment of lipids(cholesterol)continues to grow. Recent recommendations regarding potential for treatment of children as young as 8 are controversial, primarily because of the lack of data to demonstrate efficacy in terms of "hard" endpoints(i.e. mortality/MI)vs. morbidity of the therapy(i.e. cognitive dysfunction/growth delay). The intellectual underpinning of the rationale for drug therapy is this:diet/exercise are either inadequate and/or poorly complied with for many people, atherosclerosis starts sooner than most people realize, delaying therapy until adulthood may be too late to prevent the process(rather than simply arrest or reverse it). A very small group of people with relatively rare genetic predisposition to high cholesterol would be candidates for therapy in light of very premature cardiac event rate. In the absence of controlled trial data, we cannot assume that the beneifts of drug therapy outweigh the risks.

Don't use a dangerous fix for for a probem that may not exist!

July 21, 2008

Analysis by: GLG Expert Contributor

Analysis of:8-Year-Olds on Statins? A New Plan Quickly Bites Back | www.nytimes.com

We do not know enough about the effects of statins over a lifetime to justify use in children. Maybe we would reduce cardiovascular mortality, maybe not.  But at what cost?  I'm talking about both financial costs and the health costs related to drug side effects.  We need a lot more information before recommending this course of action for all children with abnormal lipids. A better idea is to improve dietary habits and increase physical activity in our children.  A pill is not the answer to good health!

Starting Younger Every Day

July 18, 2008

Analysis by: GLG Expert Contributor

Analysis of:8-Year-Olds on Statins? A New Plan Quickly Bites Back | www.nytimes.com

While I am sure that there are a few children with hereditary lipid disorders which should be treated aggressively and early with statins, the data is certainly not available to support routine treatment of every child with elevated lipid values.

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